Andhra Pradesh

East Godwari-II at Rajahmundry

CC/99/2009

Gubbala Yamini - Complainant(s)

Versus

Ambajipeta Womens Hospital Association - Opp.Party(s)

K. Barani Kumar

11 Nov 2016

ORDER

                                                                                             Date of filing:    24.06.2009

                                                                                      Date of Order:  11.11.2016

 

BEFORE THE DISTRICT CONSUMER FORUM-II, EAST GODAVARI

DISTRICT AT RAJAMAHENDRAVARAM

 

PRESENT:   Smt H V Ramana, B.Com., L.L.M.,   …  PRESIDENT(FAC)

                                 Sri A. Madhusudana Rao, M.Com., B.L., … MEMBER

                 

Friday, the 11^th day of November, 2016

 

C.C.No.99 /2009

Between:

 

Gubbala Yamini, W/o.Satyanarayana,

D/o.Keta Bhaskararao, Hindu, age 22 years,

Annamvarithota, Nadampudi, Ambajipeta

Mandal, E.G. District.                                                                                                                   ….       Complainant

 

                        And

 

1)  Ambajipeta Womens Hospital Association,

     Rep. by its General Superintendent,

     Regd. Charitable Society No.296/70,

     Ambajipeta – 533 214, E.G. District.

 

2)  Dr. Ch. Giribala,

     Medical Officer, Gynecologist,

     Ambajipeta Womens Hospital Association,

     Ambajipeta – 533 214, E.G. District.                                                                                      ….       Opposite parties

 

            This case coming for hearing on 02.11.2016 before this Forum after remanded from A.P. State Consumer Disputes Redressal Commission, Hyderabad for reconsideration, in the presence of Sri K. Bharani Kumar, Advocate for the complainant and Sri Ch. Prabhakara Rao, Advocate for the 1^st opposite party and the 2^nd opposite party having been set ex-parte, and having stood over to this date for consideration, this Forum has pronounced the following: 

O R D E R

[Per Smt. H.V. Ramana, Lady Member & President (FAC)] 

          This is a complaint filed by the complainant U/Sec.12 of Consumer Protection Act 1986 to direct the opposite parties to pay Rs.6,00,000/- towards compensation for the deficiency of services and the negligent treatment by the opposite parties 1 and 2 towards the expenditure spent by the complainant and for mental agony and pain and suffering and award costs of the complaint. 

2.         The case of the complainant is as follows:- The complainant stated that she was pregnant and the same was confirmed by Kranthi Maternity Hospital, Kothagudem on 4.8.2007.  The complainant attended for regular checkup and later she went to her parent’s house for delivery at Ambajipeta.  On 12.11.2007, she approached the 1^st opposite party hospital and where the 2^nd opposite party working as Gynecologist and she got checkup with her vide receipt No.573.  The complainant used to follow the advice and medicines prescribed by the 2^nd opposite party.  She joined in the 1^st opposite party’s hospital for a delivery on 7.5.2008.  The complainant admitted as inpatient No.1139/08 after making checkups and tests by the 2^nd opposite party.  The 2^nd opposite party informed the elders of the complainant that the baby in the womb not in turned and further, it requires low work segmental caesarian section operation.  On the same day, the 2^nd opposite party operated the complainant at 9-25 PM, she gave birth to a male child.  The complainant was not required well after the surgery and her health day by day is coming down.  On 9.5.2008, when the complainant could not the motion and complained to the nurse working under the control of 2^nd opposite party gave a tablet to the complainant.  The complainant again made a complaint to the 2^nd opposite party that she was not able to pass stools and on that the 2^nd opposite party gave a tablet and asked to eat a banana.  Even then, the complainants was not having her motion then the 2^nd opposite party on 13.5.2008 conducted anima, on that the complainant developed abdominal distention and from on that day, she had high fever.  The 2^nd opposite party gave an injection to the complainant, but the fever was not controlled, became unconscious and unable to move from bed and developed breathlessness.  On that the 2^nd opposite party, opened the abdomen and become septic, on the next day i.e. 14.5.2008, the complainant gave medicines, even then her health was degenerated.  The 2^nd opposite party gave a referral letter to shift her to Dr. Cheeranjivi Raju Hospital, Amalapuram in their ambulance with oxygen and nurse.  Due to the mistake of the 2^nd opposite party, and due to her negligence, the complainant reached to the stage of death, this amounts to deficiency in service.  The complainant was admitted in V.N. Nursing Home, Amalapuram and underwent treatment after diagnosis of septicemia, renal failure, shock due to the post operative burst abdomen infection and necrosis of local tissues and organs.  The complainant was treated debredement was done for four times and removed necrosed dead tissues and later she undergone skin grafting and the same was done by Dr. Ganga Kishore (Plastic Surgeon). The complainant was treated in the hospital till 20.7.2008.  Therefore, the complainant submits due to negligent post operative treatment of the opposite parties, she suffered lot of mental agony. Hence, this complaint.                

3.         The opposite parties filed written version contending as follows:- The opposite parties denied all the allegations made by the complainant. The opposite parties submitted that the 2^nd opposite party is working in the 1^st opposite party hospital.  The 2^nd opposite party thoroughly examined the complainant and explained the condition of the complainant to her attendants.  The 2^nd opposite party found that there was foetal heart variability with the help of CTG after having administered dextrose and oxygen.  Finally, the 2^nd opposite party conducted per-vaginal examination that there was cephalopelvic disproportion and reappearance of foetal heart variability even during the time of taking conservative measures. Basing on the above observation, she conducted lower segment caesarian section which was clearly explained by her to the attendants of the patient.  The complainant delivered a male child on 7.5.2008 at 9-22 PM and she was shifted to post operative ward and her general condition was found good.  She was administered necessary antibiotics and necessary medicines with reasonable care.  The complainant shifted to regular ward and her general condition was good.  The complainant complained on 13.5.2008 during the routine rounds, that she was not passing motion since the time of surgery.  She was advised to take Ducolax tablets.  Again on 14.5.2008, the complainant made the same complaint and she was given anima.  Then it was noticed that there was abdominal distention and the bowel sound was sluggish.  This opposite party noticed that there is surgical wound infection and immediately sutures were removed and dressing was done.  The complainant was given I.V. fluids, antibiotics. The blood pressure and pulse rate were stable.  On 15.5.2008, the complainant complained breathlessness and her blood pressure were found to be 90/40.  Then immediately the drip was given with 5% dextrose.  The 2^nd opposite party also noticed that tachycardia (high pulse rate) in the patient, immediately oxygen was administered.  It was then diagnosed that there was septicemia, it is one of the complications after caesarian section.  Multiple factors may play a role in etiology of septicemia.  The 2^nd opposite party consulted the attendance of the complainant to shift her to a higher institute for further management.  Accordingly she was shifted to Amalapuram.  These opposite parties have take reasonable care while conducting the operation and also extending post operative care to the complainant and further stated that they are not negligent while conducting the surgery and there is no deficiency in service on their part.  Hence, the complaint may be dismissed.                     

4.         The complainant in proof of her case examined herself as P.W.1,                        Dr. B. Nageswara Rao, who is a senior resident medical officer of V.N. Nursing Home as P.W.2, and Dr. V. Ganga Kishore, Plastic Surgeon of Rajahmundry as P.W.3 and Ex.A1 to A12 have been marked on behalf of the complainant.  The 2^nd opposite party examined herself as R.W.1.

5.         The opposite parties preferred an Appeal before the Hon’ble A.P. State Commission and filed the Medical record of the complainant, which is maintained by their hospital before the Hon’ble A.P. State Commission in FAIA No.2370 of 2014 in FA No.686 of 2013. The said Medical record is marked before the Hon’ble A.P. State Commission vide Ex.B1. The Hon’ble A.P. State Commission remanded the matter by setting aside the earlier order given by this Forum and ordered this Forum to reconsider the matter by going through Ex.B1.                 

6.         Heard both sides. 

7.         Points raised for consideration are:

 

1. Whether there is any deficiency in service on the part of the opposite parties?

2. Whether the complainant is entitled for the reliefs asked for?

            3. To what relief?  

 

8.         Initially, the complainant took treatment in Kranthi Maternity Hospital at Kothagudem vide Ex.A1.  Subsequently, she went to her parents house at Ambajipeta for delivery and approached the opposite parties on 12.11.2007 and got her checkup vide Ex.A2.  Since then she was taking treatment with the opposite parties till her delivery.  The complainant paid the delivery charges and hospitalization bills to the opposite parties vide Ex.A.3.  After shifting to V.N. Nursing Home, she underwent different tests and also purchased various medicines vide Exs.A4 and A5.  She also filed the discharge summary given by V.N. Nursing Home vide Ex.A6.  The V.N. Nursing Home bills filed by the complainant vide Ex.A7.  The complainant got issued a legal notice vide Ex.A10 and also received reply vide Ex.A12. 

            It is an undisputed fact that the 2^nd opposite party is a medical practitioner and was working in the 1^st opposite party’s hospital in the name and style of Ambajipeta Women’s Hospital Association, Ambajipeta and it is also not in dispute that the complainant was taking treatment in the 1^st opposite party’s hospital since 12.11.2007 vide Ex.A2.  When the complainant admitted in the hospital for delivery, the doctor i.e. 2^nd opposite party conducted caesarian section on 7.5.2008. After regaining her conscious, the complainant complained that she was having pains in her body and she was having abdominal pain and could not pass stools.  For which, the 2^nd opposite party gave some tablets and also conducted anima on 13.5.2008, on that the complainant developed abdominal distention and she developed high fever from that day and she became unconscious and unable to move from bed and developed breathlessness. The sutures over the abdomen were not healed due to infection and the abdomen was opened became septic. Later, the complainant was shifted to V.N. Nursing Home, Amalapuram and admitted her as inpatient on 15.7.2008.

            The opposite parties denied the allegations made by the complainant, but they admitted that the complainant was hospitalized on 7.5.2008. The 2^nd opposite party is working as a doctor in the hospital of the 1^st opposite party by then. The opposite parties submitted that the 2^nd opposite party thoroughly examined the complainant and found that there was foetal heart variability with the help of C.T.G. and after having administered the medicines and explained the condition of the complainant to her attendants. After examination of the complainant, there was cephalopelvic disproportion and reappearance of foetal heart variability even during the time of conservative measures. In such circumstances, the 2^nd opposite party took a decision and conducted caesarian section and explained to the attendants of the complainant. The complainant delivered a male baby at 9.22 PM on 7.5.2008. Immediately, the patient was shifted to postoperative ward and her condition was found good. The 2^nd opposite party further submit that she administered necessary antibiotics and other medicines from the day one and attended regularly and took all the reasonable necessary care. The 2^nd opposite party further submitted that all the necessary care was taken by her and her staff till 13.5.2008. The complainant made a complaint that she could not pass motion since the time of the surgery and she was advised to take dulcolax tablet. Again, on 14.5.2008, the complainant made the same complaint and she was given enema. Then, the 2^nd opposite party noticed that there was abdominal distention and bowel sounds were sluggish and it was found the surgical wound was infected. Immediately, this opposite party removed the sutures and did dressing and started giving I.V. Antibiotics. At that time, her blood pressure and pulse rate of the patient were stable and she was continuously monitored. On 15.5.2008, the complainant complained breathlessness and her blood pressure was found to be 90/40. The doctor immediately kept the complainant on medicines and noticed Tachycardia (High pressure rate) in the patient. Immediately oxygen administered and ryles tube aspiration was done. Then, it was found that there was septicemia. She further submitted that septicemia is one of the complications in caesarian sections. For this infection, multiples factors may play a role and she was shifted to Amalapuram with the assistance of the staff of the 1^st opposite party. The 2^nd opposite party submitted that she has taken all the precautions and care and conducting the operation even then, the complainant developed septicemia which is a common complication in such surgeries. Therefore, there is neither negligence nor deficiency in service towards the complainant as alleged in the complaint.  

            The opposite parties filed the Medical record of the complainant vide Ex.B1 before the Hon’ble State Commission on the file of FAIA No.2370 of 2014 in FA No.686 of 2013 and submitted that the said document is crucial to determine the medical negligence on their part.  

9. Point Nos.1 and 2:- The complainant contended that ever since she came to her parents place for delivery, she undertook treatment with opposite parties 1 & 2 and she also delivered a male child on 7.5.2008.  After the delivery, on the fourth day, she complained that she could not pass stools and the 2^nd opposite party gave medicines to the complainant.  Even then, when she could not pass the motion, the 2^nd opposite party on 13.5.2008 conducted anima. The complainant further contended that she developed abdominal distention and got high temperature and became serious.  The 2^nd opposite party gave injection even then she could not recover and became unconscious and unable to move and developed breathlessness. The sutures over the abdomen were not healed due to the infection and the abdomen was open and became septic.  Again, she contended that on 14.5.2008, the 2^nd opposite party administered some I.V. fluids till next day, even then her health was not improved and started deteriorated.  Immediately, the 2^nd opposite party advised her family members to shift her to a better hospital and gave a referral letter to Dr. Cheeranjeevi Raju.  The complainant also contended that after admitting her in V.N Nursing home, the doctors diagnosed and treated her for septicemia, renal failure shock due to the post operative burst abdomen infection and necrosis of local tissues and organs and further treated for debredment was done.  Later Dr.Ganga Kishore, Plastic Surgeon did the skin grafting to the abdomen.  She contended that she was treated in V.N. Nursing Home from 15.5.2008 till 20.7.2008 and spent lot of amount for treatment and medicines because of negligent post operative treatment given by the opposite parties, she had lot of pain and mental agony due to the acts of the opposite parties.

            P.W.2 in his evidence submitted that after conducting caesarian section, the complainant was admitted in their hospital on 15.5.2008 in an unconscious stage with severe dysponea and brought her to their hospital with oxygen supply and she was also in a stage of burst abdomen with septicemia, shock and renal failure.  He further submitted that by the time she was brought to the hospital, she was with abdomen necrosis of the tissues.  Immediately, the blood test was done and basing on the reports, she was anemic and the readings of blood urea, creatin in blood are increased and also submitted such readings indicate the patient became anemic and also grade-II renal failure.  As per the test reports and the condition of the patient, she was suffered with septicemia.  The P.W.2 further submitted that lack of movement in bowels is due to infection in the wound.  In any case of infection in surgical wound on the abdomen, the first thing is to open the sutures and put the patient on high antibiotics and drain out the infection instead of allowing it to extend into the other parts of the body namely, the intestines, liver, kidneys and spleen. In case of Septicemia, the finding of abnormality in the vital organs found in such cases, the patient will be referred to the higher centers for necessary treatment and attention.  The opposite parties were not placed the reports of the complainant at the time of admission of P.W.1 before V.N. Nursing Home.  P.W.2 also submitted that the plastic surgery done to P.W.1 is due to need, but due to cosmetic reasons. 

Dr.G. Ganga Kishore was examined as P.W.3. In his evidence he submitted that he has done split skin grafting at V.N. Nursing Home for post operative raw area over anterior abdominal valve of the complainant.

The 2^nd opposite party was examined as R.W.1.  She submitted that the complainant approached her for medical checkups and used to follow the advice and medicines prescribed by the R.W.1.  She advised the complainant to admit in the 1^st opposite party hospital as inpatient after making checkups, she informed the elders of complainant, it is requires lower segment of caesarian section operation.  On the same day, the complainant gave birth to the male child at 9-20 PM.  On 9.5.2008, the complainant made a complaint that she was unable to pass motion and R.W.1 gave some medicines.  Again on 13.5.2008, when the complainant could not pass the motion, R.W.1 conducted anima.  The next day i.e. on 14.5.2008, the complainant developed abdominal distention and became unconscious.  Due to infection, the abdomen was opened and it is noticed that there is infection when the complainant health was deteriorating, she was admitted to V.N. Nursing Home, there they have conducted several tests and administered medicines vide Ex.A5.  She also submitted that she visited the patient once while she was in V.N. Nursing Home.  By that time, the complainant was taking treatment.

This matter was referred to an expert on the request of the complainant and the expert Dr. Lavnya Kumari .S., Associate Professor, Obst. & Gyn., Rangaraya Medical College, Kakinada in that report she stated that “Pre-operative condition of the patient and P.O. Administration of Antibiotic details not known.  Therefore, I do not find any evidence of negligence as per the records.”

The opposite parties’ counsel contended that Septicemia is a common infection in all surgeries as soon as the 2^nd opposite party realized when the complainant got infected with septicemia, she herself suggested to shift the patient to a bigger hospital. This opposite party filed Ex.B1 before the Hon’ble State Commission and marked by them, in which she herself mentioned in discharge summary that “the complainant was diagnosed with fever and the patient developed breathlessness and abdominal distention was not decreased, B.P. was found to be 90/40 mm Hg. Tachycardia was present. Dopamine drip was started in 5% Dextn. At the rate of 8 dropn/min. O2 was administered. Ryle’s tube aspiration done. She was diagnosed as having Septicemia. The patient condition was explained to the attendants and shifted the patient to Care Hospital (Dr. Chiranjeevi Raju) for further management. The complainant complained that she has not passed motion on 13.5.2008 and the same is mentioned by the doctor in her case sheet and also same is mentioned in her evening visit and mentioned same treatment can be continued and she found on 14.5.2008 at 8-00 PM abdominal distention + BS sluggish wound foul smelling discharge from wound, she shifted to minor O.P. and also mentioned septic precautions, sutures removed, wound gapping + slough excised and dressing done.           

After perusing the entire medical record and other evidence, we observed that the complainant paid an amount vide Ex.A3 to the opposite parties 1 & 2 and obtained services from them. In the present case, the complainant’s health was deteriorated due to septicemia and various complications were arose and she was shifted from 1^st opposite party’s hospital to V.N. Nursing Home.  After joining the complainant in V.N. Nursing Home, they made several tests periodically and also administered various medicines as per Ex.A5.  The consultant doctor of V.N. Nursing Home gave the discharge summary report vide Ex.A6.  In this, it is categorically stated that they diagnosed that the patient was having Post Operative Burst Abdomen with Necrosis Septicemia under Shock and Renal Failure and also submitted that debredement was done four times to remove necrosed dead tissues.  Wound healed with regular dressing and medications.  Skin Grafting was done by Dr. Ganga Kishore (Plastic Surgeon). P.W.2 in his evidence, he clearly stated that the plastic surgery done to P.W.1 is due to the need, but not due to cosmetic reason. They also mentioned that they treated with Broad spectrum Antibiotics, and Anti Inflammatory and supportive, I.V. Fluids. Patient recovered well and Haemodynamically stable at the time of discharge.  The entire treatment given by V.N. Nursing Home doctors from 15.5.2008 to 20.7.2008.

In this case, as per our observation this forum has sent only record available with them i.e., the medical record of Kranthi Meternity Hospital and the medical record of V.N. Nursing Home to the expert doctor to give opinion, but the medical record of the complainant maintained by the opposite parties was not sent along with the other medical records for the opinion. The counsel for the opposite parties contended that the complainant failed to opt for the medical opinion by sending the entire medical record along with Ex.B1 for fresh consideration after remanded the matter from the Hon’ble State Commission and also contended that Septicemia is a common problem in cases of conducting surgeries. The complainant’s counsel argued that the burden of sending the medical record for the expert opinion will lies on the opposite parties as they furnished the same before the Hon’ble State Commission. They also further contended that the doctor herself mentioned in Ex.B1, the complainant had infected with Septicemia and shifted the patient to Care Hospital for further management. The opposite parties contended that in all surgeries patients will be infected with septicemia, but they cannot generalize that in all cases patients will effect with septicemia, it also occurs due to unhygienic conditions.

As per the above observation, we noticed that the complainant was delivered a male child on 7.5.2008 and she complained that she could not pass motion from 13.5.2008. Even on 14.5.2008 also she could not pass the motion. As per Ex.B1, she visited twice on 13.5.2008 and referred to continue the same treatment for passing of the motion, she referred Dulcolax. Again on 14.5.2008 at 8.20 AM, she visited the patient and stated to continue the same medicine. The 2^nd opposite party administered enema without making any thorough checkup to the complainant and on the same day at        8.00 PM she noted that there was abdominal distention and wound gapping and other complications on 15.5.2008, she suffered with breathlessness and fall of blood pressure and referred to Care Hospital. Due to the infection of septicemia, the complainant suffered more than two months after the surgery done by the opposite parties and she was kept in the hospital and incurred lot of expenditure for the hospitalization and medication and she may not even take care of new born child due to her suffering pain and mental agony.

            It is settled law, it is clearly stated that if a patient is suffering from infection and referred to a bigger hospital for better management which amounts to deficiency in service on the part of the opposite parties. The 2^nd opposite party who treated the complainant is the employee of the 1^st opposite party. Therefore, the 1^st opposite party is vicariously liable for the acts of their employee.

 In this case, had the doctors have taken the post-operative care correctly, the complainant would not have suffered the infection of the wound and her condition was no so seriously effected and it shows that the negligence of hospital authority, which amounts to deficiency in service. The R.W.1 filed the medical record before the Hon’ble State Commission and marked as Ex.B1, but they have not examined her to give evidence with regard to Ex.B1.  Therefore, we opined that the opposite parties failed to prove their case as they have taken required post operative care and acted negligently towards the complainant. This shows the negligent, behavior of the opposite parties and this amount to deficiency in service on their part. 

Therefore, we opined that the complainant is entitled the amount in the final bill issued by V.N. Nursing Home vide Ex.A7 dt.20.7.2008 for Rs.99,400/- and she is also entitled the expenditure incurred for medicines and tests vide Ex.A5 around Rs.30,000/-.  Due to the negligent acts of the opposite parties, the complainant had suffered lot of pain and mental agony on account of deficiency in service rendered by the opposite parties, for this we grant a sum of Rs.50,000/- towards damages for mental agony, pain and suffering.    

     

                 

10.  Point No.3:- In the result, the complaint is partly allowed, directing the opposite parties to pay a total amount of Rs.1,74,400/- (i.e. Rs.99,400/- towards hospitalization in V.N. Nursing Home, Rs.30,000/- towards medicines and tests and Rs.50,000/- towards damages for mental agony, pain and suffering) to the complainant.  The opposite parties are further directed to pay Rs.3,000/- towards costs.  Time for compliance is two months from the date of receipt of copy of this order. 

Dictated to the Stenographer, typed to my dictation, corrected and pronounced by us in open Forum, on this the 11^th day of November, 2016.

                                             

      MEMBER                                                                              PRESIDENT (FAC)

 

 

 

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

 

FOR COMPLAINANT:                                                                                                        FOR OPPOSITE PARTIES:  

 

 

P.W.1 :  Smt.Gubbala Yamini (Complainant)                    R.W.1 : Dr. Ch. Giribala (2^nd O.P.)

P.W.2 :  Dr. B. Nageswara Rao, V.N. Nursing Home

P.W.3 :  Dr. V. Ganga Kishore, Plastic Surgeon

 

DOCUMENTS MARKED

 

FOR COMPLAINANT:

 

Ex.A1  dt.4.8.2007 Treatment sheet of the complainant by Kranthi Maternity Hospital,

Kothagudem.

Ex.A2  Admission card No.5739 at Women’s Hospital, Ambajipeta.

Ex.A3  Medical bills issued by the Women’s Hospital, Ambajipeta.

Ex.A4  Bunch of Medical bills.

Ex.A5  Medical bills issued by V.N. Nursing Home, Amalapuram.

Ex.A6  Discharge summary of V.N. Nursing Home.

Ex.A7  Hospital bill issued by V.N. Nursing Home.

Ex.A8  dt.22.5.2008 The United X-ray and Laboratories.

Ex.A9  Photograph of complainant.

ExA10 dt.5.11.2008 office copy of Regd. Legal notice.

ExA11 dt.10.11.2008 Acknowledgements from the opposite parties 1 and 2.

ExA12 dt.25.11.2008 reply notice of the opposite parties.

 

FOR OPPOSTIE PARTIES:-  

 

Ex.B1  Case Sheet of complainant dated 07.05.2008.      

 

 

          Sd/-                                                                                                                  Sd/-

      MEMBER                                                                                                  PRESIDENT (FAC)